Running on Empty: The Crisis in Asthma Control

Asthmatics are living half lives, shunning exercise, medications and coughing their way through the night. It doesn’t have to be this way.

Adrienne Smith has been battling with her asthma since she was diagnosed at the age of 13. For Smith, high school gym class was particulary difficult: she would often get a crushing feeling in her chest when she started to run, and it would take her 25 minutes to recover. “It was humiliating,” she says.

Now, at 30, Smith’s asthma is still a big part of her life. She doesn’t play competitive sports any more, something she used to enjoy. And when she works out, she tends to walk, rather than run. When her asthma is at its worst, it keeps her up at night. During these bouts, she finds ordinary household chores arduous, such as carrying laundry up the stairs.

Still, Smith, who lives in Victoria, B.C., feels she’s doing fairly well. “I haven’t been to the hospital this year,” she says. “So that’s a good sign.” While she finds her limitations frustrating, she accepts them as a part of who she is. “I don’t think I’m sickly. It’s just that sometimes I have these episodes.”

About three million Canadians have asthma – one of the highest incidences in the world – and the majority of those affected share Smith’s conception of the disease.

“They think it’s normal to be short of breath, waking up at night, or not being able to perform exercise,” says Dr. Louis-Philippe Boulet, a respirologist and asthma researcher at Laval University in Quebec City. “I saw a patient recently who had stopped exercising; he started playing chess. He almost couldn’t do anything. But it was normal for him.

“Research shows 28 per cent of Canadians with asthma have symptoms of their disease every day, while 67 per cent have symptoms every week. But the experts agree that this should not be the case; that asthma is completely controllable. In the right environment and with the right medications, even those with severe asthma should have relatively few symptoms.

That’s because the medications available today can prevent the inflammation of the lungs, and the resulting constriction of the bronchial tubes and mucus build-up.

It’s possible to develop an asthma action plan in which, by reducing bronchial inflammation with medication and avoiding asthma triggers, the patient should rarely have to stop to catch a breath. And that blue “rescue” inhaler that many asthmatics depend on to treat frequent symptoms? It should only be used occasionally.

However, this ideal is far from reality. Instead, the majority of Canadian asthmatics are living half-lives. They aren’t exercising, which can lead to a host of other health problems, like obesity, diabetes and heart disease. They are missing school and work, and giving up activities they enjoy.

They see their doctors, but these visits are often marked by poor communication. They end up in the hospital after days of worsening symptoms. They are Canada’s “walking wounded,” and they’re slipping through the cracks of our health-care system. Amazingly, most of them don’t even realize they have a problem.

The statistics show just how bad it is. Six years ago, the Asthma Society of Canada announced that 57 per cent of Canadians with asthma did not have their disease under control. The society’s latest research, released in September 2006, shows no sign of improvement; more than half of asthmatics are still living with symptoms above what are considered acceptable levels.

Earlier findings showed 10 per cent of them had landed in the emergency room at least once in the previous year because of an asthma attack, and 12 per cent reported missing school or work.

In Ontario alone, hospital statistics show that asthmatics made more than 73,000 emergency room visits in the past year. National statistics are not available, but the numbers are known to be uniformly high.

“Certainly for children, we know that it is one of the most common reasons for emergency visits,” says Jan Haffner, vice-president of health initiatives for the Lung Association of Saskatchewan.